This document contains a comprehensive collection of medical consultation reports from various patients, documenting evaluations for conditions including renal failure, hypertension, electrolyte imbalances, and other complex medical issues. Each consultation provides detailed patient histories, physical examinations, laboratory findings, impressions, and treatment plans.
PATIENT NAME: _____, _____
ELECTROENCEPHALOGRAM:
This is a routine electroencephalogram recording showing background activity consistent of fairly well developed well organized rhythm in the range of 6 to 7 cycles per second of low amplitude. The recording is bilaterally symmetrical high voltage activity in the range of 4 to 5 cycles per second activity lasting from 2 to 3.5 cycles per second intermittently in a generalized pressure without any definite periodicity.
Artifact with EKG and respirator were seen to be _____05:01.
Photic stimulation and hyperventilation were not reviewed.
IMPRESSION: This is abnormal electroencephalogram recording with clinically generalized limited functions with _____05:07 seizures. However, no seizures are noted clinically during the recording.
ABDUL R. MAMSA, M.D.
ARM/atl DD: 09/11/2007 18:38 DT: 09/12/2007 09:15
For evaluation of elevated BUN and creatinine.
The patient is a 77-year-old Caucasian, nursing home resident, who was brought into the emergency room last night after the patient was found unresponsive with shortness of breath. The patient, in the emergency room, was found at first with a blood pressure of 80/40. He received the administration of IV fluids, consistent of normal saline, at a dose of 500 cc x3 doses. Upon further evaluation, he was found with increased troponin and increased levels of brain natriuretic peptide and a diagnosis of left ventricular dysfunction, most likely associated to ischemia, and heart failure was made. The patient has not diuresed as much despite the administration of Lasix 20 mg on two occasions. Upon further evaluation, he was found with a serum creatinine of 2.9 mg/dL, the reason why this consultation has been prompted.
Remarkable for aphasia, history of previous stroke with left-sided hemiplegia, history of hypertension, and hyperlipidemia. The patient is a nursing home resident.
He has been on trazodone, Lipitor, Lopressor, Phenergan, and Percocet.
Probably multifactorial, rule out hemodynamically mediated glomerular dysfunction secondary to hypotension, versus secondary to decreased cardiac output in the setting of the compensated congestive heart failure, versus septic acute renal failure.
The patient has a baseline serum creatinine between 1.3-1.4 mg/dL. Potential etiologies include hypertension and nephrosclerosis. His estimated glomerular filtration rate is 53 mL/minute.
Rule out acute non-Q wave myocardial infarction.
Sepsis syndrome with rapid atrial fibrillation.
Cardiomyopathy with left pleural effusion.
Rule out mediastinal mass and pericardial effusion.
Severe hypomagnesemia with high anion gap metabolic acidosis.
Should suspect cholelithiasis versus sharp liver.
His blood pressure at this moment is 110/50 and heart rate is 120.
He is awake, alert, but he cannot articulate.
Blood gas analysis shows pH of 7.47, PO2 of 96, bicarbonate of 17, and lactic acid 3.4.
Hemoglobin is 10, hematocrit 31%, platelets 143,000, and white blood cell count 9.0.
The patient has been admitted to the Intensive Care Unit. The patient's blood pressure now is much better. When he was at the emergency room, his blood pressure was 80/40. He was bolused with normal saline, 500 cc on three occasions, receiving a total of 1500 cc of fluid. However, the patient has developed atrial fibrillation with fast ventricular response. He remains clinically with congestive heart failure. A dose of intravenous diuretics has been provided in order to enhance the elimination of free water. Cardiologist has been consulted to follow up on this patient.
Maintain hemodynamic stability with IV fluids and monitoring
Obtain urine electrolytes for quantification of the fraction of excretion of sodium
Monitor closely; no renal replacement therapy needed at this moment
Thanks Dr. _____09:06 for allowing me to participate in the care of this patient. We will follow closely with you.
ELPIDIO A. ABREU, M.D.
EAA/ATL DD: 08/14/2007 12:23 DT: 08/15/2007 04:17
This document contains numerous additional consultation reports from Dr. Elpidio A. Abreu, M.D., covering a wide range of nephrology consultations. The reports document evaluations for patients with various conditions including:
Multiple etiologies including hemodynamically mediated dysfunction, volume depletion, and sepsis-related causes
Various stages and causes including diabetic nephropathy, hypertensive nephrosclerosis, and ischemic nephropathy
Hyponatremia, hyperkalemia, hypomagnesemia, and metabolic acidosis
Patients on maintenance hemodialysis requiring ongoing management and dialysis continuation
Throughout the consultation reports, several recurring clinical patterns emerge that demonstrate the complexity of nephrology care:
The consultations consistently emphasize comprehensive management strategies including fluid management, medication adjustments based on renal function, electrolyte replacement, and careful monitoring. Many patients require coordination between nephrology and other specialties including cardiology, infectious disease, and critical care medicine.
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Medical Consultation Reports